Supervisor, Complaints, Grievances & Appeals

Remote Opportunity: 1

Requisition Number: 3220

Position Title: Supervisor, Complaints & Grievances

External Description:

JOB SUMMARY:

The Complaints and Grievances Supervisor oversees the Complaints and Grievances Specialists to ensure compliance
with client regulatory requirements. The Complaints and Grievances Supervisor monitors turnaround times, prepares
Client Corrective Action Plans, audits files, and assists in the ongoing evaluation of departmental policies and
procedures.

PRIMARY JOB RESPONSIBILITIES:
• Monitor complaints, grievances, appeals and Fair Hearing turnaround times to ensure compliance with client
contracts on a daily basis.
• Ensure regular communication with the Customer Service Department to maintain open lines of
communication between C&G and Customer Service. Provide ongoing auditing of files for C&G team
members.
• Prepare Client Corrective Action Plans and ensure compliance.
• Identify and communicate client expectations and regulatory requirements to ensure compliance with member
and provider complaints and appeal letters.
• Assist in the hiring process, including interviewing candidates.
• Assist in the ongoing evaluation of departmental policies and procedures.
• Assist in the preparation of performance and wage evaluations in accordance with company policy.
• Ensure quality and accuracy of data for client audits.
• Provide clear written correspondence at all times.
• Perform accurate and on time reporting on monthly and quarterly basis.
• Coordinates and implements appropriate strategies for motivating team members.
• Conduct monthly staff meetings and quarterly department meetings.
• Assist in the formal training of all new and existing team members.
• Approves attendance and time off for all direct reports.
• Maintains working relationships with plan contacts.
• Attends regular meetings, as needed.
• Reviews/approves timesheets.
• Adhere to DentaQuest business practices.
• Other duties as assigned.

JOB REQUIREMENTS:
• Bachelor’s Degree or equivalent experience.
• 1 year related supervisory experience in an office setting is required.
• Previous experience working with regulatory requirements and direct contact with clients required.
• Excellent analytical skills.
• Knowledge of general computer software (Excel, MS Word and Access).
• Excellent verbal communication skills.
• Excellent writing skills.
• Excellent interpersonal skills.
• Ability to prioritize and organize multiple tasks.
• Ability to remain organized with multiple interruptions.
• Required to attend additional training as requested/deemed necessary.

PHYSICAL DEMANDS:
• Incumbent must be able to communicate effectively.
• Requires overall light physical effort (up to 25lbs.)
• Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use
of personal computer).
• Ability to travel or move about within and outside serviced facilities required.
• Incumbent works primarily in either a private or shared office environment.

City: Milwaukee

State: Wisconsin

Community / Marketing Title: Supervisor, Complaints, Grievances & Appeals

Company Profile:

At DentaQuest, we believe that everyone should live life free of dental disease. As a purpose-driven, double bottom line company that is improving oral health for everyone, we are transforming the oral health system – from the way we provide care and pay for it, to how we talk about it and prioritize it in our policies and communities.

Meaningful change requires a revolution in oral health. We are redefining what it means to prevent disease and provide better access to care for everyone. We are going beyond the dental chair to reshape the oral health system, addressing total health and the social and cultural factors that impact it. 

To make this revolution a reality, we harness our unique reach and insights to advance policy, financing, care, and the community. That means solving problems in a flexible and efficient way, testing and trialing to create new solutions and delivering measurable outcomes for the people we serve.

The people of DentaQuest have a common purpose, and we work together with passion, perseverance and focus to achieve a nation where no child suffers from the pain of tooth decay. Where adults keep all their teeth for their entire lives. Where every person has access to quality dental care.

Location_formattedLocationLong: Milwaukee, Wisconsin US

CountryEEOText_Description: Equal Employment Opportunity Statement: DentaQuest is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, sex, age, disability, marital status, or sexual orientation.